Common Breastfeeding Questions and Problems - Article Three

Is Baby Getting Enough?
How do I know my baby is getting enough milk? After the first month or two you will know intuitively that your baby is getting enough milk. He/she will feel and look heavier. In the first few weeks, however, it is not as easy to tell, especially if you are a first-time mother. Here are some signs baby is getting enough milk in the first weeks.

* A baby who is getting a sufficient volume of milk will usually have at least six to eight wet cloth diapers (four to six disposable diapers) per day after the initial three days of start-up time. Enough wet diapers tell you that you baby is safe from dehydration.

* Your baby's stool changes give you another clue to how much milk he/she is getting. In the first week the baby's stools should normally go from sticky black to green to brown; as soon as your rich, creamy hindmilk appears, stools become more yellow. Once baby's stools becomes like yellow, seedy mustard, this is a sign that your newborn is getting enough of the higher-calorie hindmilk. In the first month or two a baby who is getting enough high-fat milk will usually have at least two or three yellow, seedy stools a day. Because breast milk has a natural laxative effect, some breastfed babies may even have a stool during or following each feeding.

* Your breasts may feel full before feedings, less full after feedings, and leak between feedings -- all signs of sufficient milk production and delivery. After a few months, leaking usually subsides, even though you have sufficient milk. Baby's sucking styles and level of contentment are other guides to sufficient milk. If you feel your baby sucking vigorously, hear him/her swallowing, feel your milk-ejection reflex, and witness your baby drift contentedly off to sleep, chances are he/she is getting enough milk.

How much weight should my baby gain during the first month?
A baby's weight gain is another indicator of sufficient milk. After the initial weight loss during the first week (usually 5-8 percent of baby's weight, or between 6 and 10 ounces/170-280 grams), babies getting sufficient nutrition gain an average of 4-7 ounces (115-200 grams) a week for the first few weeks, thereafter an average of 1-2 pounds (450-900 grams) per month for the first six months, and one pound per month from six months to one year. Babies usually lengthen about an inch (2.5 centimeters) a month during the first six months. Weight and height gains depend somewhat on baby's body type.

New mother's are zealous weight watchers. While it is not true that good weight gain is an index of good mothering, it is felt that a baby's weight gain may be some tangible rewards for mothers for all those days and nights of breastfeeding, especially since breasts don';t have ounce-measurement lines she can refer to.

My 10-day-old baby has plenty of wet diapers, but has not yet regained birth weight. Should I be concerned?
Baby is probably getting big enough volumes of milk, but the slow weight gain suggests that the baby may not be getting enough calories to grow. If the eyes and mouth appear moist and the baby is wetting six to eight cloth diapers or four to six disposables each day, the baby is not dehydrated. The baby is getting the fluid needed from the milk, but may not be getting enough fat. Perhaps the baby appears scrawny. A baby who is not getting enough calories cries to be fed often but fusses because of not getting satisfied. Breastfed babies who are growing and gaining well will have two to three good size stools every day. Some will soil their diapers at each feeding. What goes in one end, comes out the other. The baby who is not gaining weight may have infrequent stools -- fewer than one per day, and that one is little more than a stain in the diaper.

The baby is not getting enough of the high-fat hindmilk, which can be the problem. The thin, watery foremilk provides enough fluid for baby, but it doesn't have the extra calories needed for growth. Basically, the baby is getting "skim milk" when the baby needs "whole milk." This doesn't mean there is a problem with your milk-making ability, but you do need to improve the delivery system. I'm sure that by now you have figured out that the high-fat milk is released later in the feeding, after your milk-ejection reflex has been triggered, sending the "cream" down into the ducts. So if you automatically switch sides after five minutes or ten minutes on one breast, your baby may get only foremilk on both sides. Encourage your baby to nurse longer on each side until the milk becomes more creamy and helps baby feel good and full. A good guideline for babies who nurse actively is "finish on one breast first." Let baby decide when to switch, rather than watching the clock or a schedule.
If the baby tends to fall asleep after only a few minutes of nursing, you need to encourage longer and more vigorous nursing. When the baby starts to drift off, take him off the breast, wake him up by burping gently, and then latch on again. You may have to repeat this process several times until baby has nursed actively for at least ten to fifteen minutes. Longer, more vigorous nursing stimulates more milk-ejection reflexes and puts more meat on baby's bones.

There will be more articles to come on Common Breastfeeding Questions and Problems.